Polite Dissent

There are several problems with the presentation of Sgt. Patrick Mancini, as shown in Phantom Jack issue #2, pages 9-11. I find it distressing that the drawings of the sergeant’s uniform were so poorly done. Not only were there multiple mistakes regarding the uniform itself, but there were multiple continuity mistakes.

I can understand missing some of the finer points regarding military uniforms; I get confused at times, and I had to wear one. However, the more blatant errors are hard to ignore. Artists use references for drawing all the time, why not use a reference for drawing the Army uniform? I was able to turn up multiple reference photos/illustrations in only a few minutes of internet searching. Even worse than the uniform mistakes are the multiple continuity mistakes between panels, even panels on the same page.

Uniform mistakes:
1. Military members do not wear hats indoors.
2. The US Army Class A Uniform coat has two sets of pockets, one upper and one lower.
3. There is no name tag.
4. He is missing rank patches/insignia.
5. Other insignia/devices are missing.

Continuity errors:
Page 9, panel 1: Ribbons, no medals, no arm patches.
Page 9, panel 3: Stripes clearly evident on left epaulet
Page 9, panel 4: Ribbons, and now medals too!
Page 10, panel 4: Ribbons, no medals. Left epaulet now sporting pins instead of stripes. Left arm patch now present. Shirt collar out.
Page 11, panel 1: Ribbons, medals may be present (obscured by word balloon), shirt collar in, no arm patch, back to stripe on epaulet.
Page 11, panel 3: And Lo — there shall come a tie tack! Ribbons, no medals, and now no pockets.
Page 11, panel 5: Ribbons, no medals. Pockets are back though.

My first rotation in the third year of medical school was obstetrics/gynecology. I had started with a month of gynecological surgery at St. Johns Mercy Hospital, and now I was doing two weeks of high-risk obstetrics at St. Mary’s Medical Center. St. John’s was busy, but relatively cushy. On the other hand, St. Mary’s was not as busy, but we ended up working at least twice as hard.

A classic tonight! To get ready for Spider-Man 2, I’m going to dip into the back issue bin, and take a look at The Amazing Spider-Man #3, containing the first appearance and origin of Doctor Octopus!

Otto Octavious was a brilliant atomic researcher who experimented on dangerous radioactive materials using special metal arms of his own design. A lab explosion one day exposed him to high doses of radiation, causing brain damage and fusing his arms to him.

Hospital doctor at bedside: The X-Rays show an uncertain amount of brain damage! I’m afraid his mind has been permanently damaged!

An X-Ray is useful for showing structures (such as the bones and lungs), but will not show brain damage. While some brain damage is detectable by fancier tests — like MRIs and CT scans — many kinds of brain damage do not show up at all on radiological studies. A series of nerve and neuropsychological tests would be the best way to detect and diagnose brain damage.

It is way to early for the doctor to predict permanent brain damage “in the hours that follow [the explosion].” Because of the radiation, there would be a great deal of swelling in the brain. But this swelling is only short-term, and the brain would improve as it resolves. Long-term prognosis is better predicted by looking for chronic brain changes, not just short-term ones.

In fairness to Stan Lee and Steve Ditko, the CT scan wan’t used until the mid-1970s, and the MRI until the mid-1980s, long after The Amazing Spider-Man #3 (July 1963). Brain damage in those days would need to be diagnosed by neurological testing, not x-rays.

But the brain of Dr. Octopus — the brain which has been damaged by radiation — reacts in a bitter way…

Radiation can certainly cause brain damage. Shortly after exposure, fluid can collect in the brain, causing headaches, nausea, vomiting, sleepiness and confusion. This usually goes away on its own.

Long term brain damage from radiation can occur months or years after exposure, and consists of memory loss, progressively worsening dementia, and difficulty thinking. It can also include flawed perceptions and personality changes.

These results are all from studies of radiation levels used during treatment of brain tumors. What high-dose radiation exposure (like what Dr. Octopus was exposed to) will do to the brain has not been well studied.

I found this while searching the web for some obscure medical information. From the “There Are Always People With Stranger Obsessions Than Yours” Pile:
List of Films about Possesed Body Parts

Shane at Near Mint Heroes (finally!) brings his own thoughts to my Lost Sense of Wonder post, and brings up an excellent point that I had completely failed to recognize (but not failed to be irritated by).

This should be a good time for Fantastic Four fans as there are three different series about the FF (not counting the Human Torch series). First, there is Mark Waid’s and Mike Wieringo’s run on the Fantastic Four, highly anticipated and highly publicized. There was even a successful letter-writing campaign to bring them back after an apparently premature termination. Next came the Ultimate Fantastic Four by Brian Michael Bendis, Mark Millar, and Adam Kubert. This series brought the FF into the Ultimate universe. Finally, there is the Marvel Knights 4, by Robert Aguirre-Sacasa and Steve McNiven. Compared to the other two series, this one has seen much less praise and press.

Unfortunately, only one of the series really shines. The others are just unimpressive Fantastic Four tales or weak attempts to retell a good story.

As much as I looked forward to Waid’s run on the Fantastic Four, I haven’t found it anything remarkable. The revision of Dr. Doom from a man of science to a man of magic was clever, but the rest of that arc was a rather standard Doom story, just with “magic” substituted for “technology”. Too many of the recent stories have been dealing with the dangers of technology, and Reed is clearly the focus of Waid’s tales. Everyone else, even Doom, just acts as a foil for him. We understand that it’s Reed Richards, flawed and guilt-stricken hero, but enough already. Move on. At least Ben and Johnny get some time in the spotlight, Sue just seems to exist just to be Wife-to-Reed and Mother-to-Franklin-and-Val. I was totally unmoved by the recent trip to the afterlife and meeting with the “creator.” The peril all seemed superficial: Ben can’t get through the door to Heaven because you built it Reed! Wieringo’s art is good, but sometimes the characters look too child-like. This series does have the best covers, as they are action covers, not poster covers.

The Ultimate Fantastic Four is just a weak re-hash of the original, reminding me way too much of the “Heroes Reborn” Fantastic Four. No one has yet improved upon the original Fantastic Four origin. Reed and Sue as teen prodigies trying to open a channel to the Negative Zone just doesn’t have the visceral thrill of the tragic space flight. Reed and Ben come off the best here. Johnny is pretty much a typical tag-along comic-book style teenager. Sue is the least member of this team, too, existing solely to be rescued by the others. The de-condensed story telling works against this title, dragging out a thin story too long until it’s even weaker. And as for changing Doom’s last name? Now I can’t think of him without a picturing a certain Belgian B-movie actor. The covers are way too poster-ific.

On the other hand, I find that the least anticipated series stands head and shoulders above the others. Over at Marvel Knights 4, we have a more plausible scenario of the Fantastic Four losing their millions and having to join the workforce than in Waid’s Fantastic Four. These aren’t action-laden stories by any stretch; instead they’re character studies of each individual as they have to go out into the “real world” and face what normal non-super powered people must deal with every day. Aguirre-Sacasa has a better grasp of the characters than Waid does. The stories have been well written and every character gets a chance to shine equally here. The art by McNiven has been nice as well. The covers, while poster-styled, are better than most of Marvel’s poster covers.

So my recommendations are to pick up Marvel Knights 4, ignore Ultimate Fantastic Four, and substitute any of the Fantastic Four Essentials volumes for the currrent Fantastic Four.

It was a late fall Monday, during my third year of medical school. I had just finished a horrifically boring month of Geriatric Psychiatry at the VA hospital, and now was doing a month of Adult Psychiatry at the local psychiatric hospital. It was a locked ward, and every day we had to be buzzed in to the unit, and be buzzed out at the end of the day.

The frailty of Peter Parker’s Aunt May was legendary back in the Silver Age. But just how sick was she? Is it true she couldn’t enter a hospital without receiving an operation – even if it was just to pay her bill?

To kick off this weekend’s celebration of the medical excitement of the early Amazing Spider-Man issues, let’s look at the illnesses suffered by Aunt May in the first 3 ½ years of the comic (this covers Amazing Spider-Man issues #1-43, and annuals #1-3 – coincidentally, these are the same issues reprinted in The Essential Spider Man, Volumes 1 and 2, for those of you who want to play along at home).

The following list sums it all up nicely (my notes are in red. ASM stands for Amazing Spider-Man):

To sum up, Aunt May was in the hospital 3 times: issues #9-10, issue #17, and issues #31-34. She also received 3 operations, in issue #9, around issue #17, and between issues #33 and #34. That’s 3 operations in 3 hospital visits, quite an average!

In 46 issues, she had 3 operations. That’s 1 operation every 15.3 issues. She was in the hospital for a total of 7 issues, or 15.2% of the time. At this rate, by the time Amazing Spider-Man had reached issue #500, she would have had 33 surgeries, and been in the hospital for a total 75 issues…

In Amazing Spider-Man #10 (March 1964), Aunt May is recuperating in the hospital after undergoing surgery in the previous issue. Peter Parker comes to visit her after the surgery. He meets with the doctor, who tells him:

Your aunt is doing as well as can be expected, son, after her operation…but she does need a blood transfusion! What is your blood type?

Peter hesitates, afraid of causing problems for Aunt May with his radioactive spider-tainted blood, but ultimately relents and provides blood for a transfusion.

Why does the doctor need blood from Peter for a transfusion? Aunt May is a relative by marriage, not blood, so Peter has no better chance of matching her blood type than a random person off the street. Furthermore, blood banks had been established in the United States starting in 1937. By 1962, there were 4,400 hospital blood banks, 123 community blood centers, and 55 American Red Cross blood centers in the United States. Certainly a hospital in New York City would have a blood bank – or at least access to a community blood bank — and they shouldn’t need Peter’s blood at all (except as a plot point).

Before the transfusion, Peter’s blood is tested:

Lucky for me my blood checked out okay! The tests didn’t reveal my super qualities!

The hospital only checked for blood type, so of course the tests wouldn’t show any spider qualities.

The physician then proceeds to transfuse Peter’s blood directly into Aunt May. This is unusual because even directly donated blood is purified and concentrated so that only the needed portions (in this case the red blood cells) are transfused. Otherwise, fluid overload may result — especially in frail elderly ladies.

Finally, the hospital is using glass bottles to hold the blood, which was anachronistic even in 1964. Plastic bags for storage and transfusion of blood had been developed in 1950 and gone into widespread use almost immediately. I would strongly recommend that Aunt May find a better hospital next time.

Returning to Peter, as he was donating blood, he was worried about his powers:

If my strength comes from my blood, which was affected by the spider’s bite, how will this transfusion affect me? I’ll probably be weakened for a while, until the blood cells can replenish themselves!

He is right to be concerned. After a blood donation, no strenuous activity or heavy lifting is recommended for 24 hours. While it takes less than one day for a person to replenish the fluid lost in donation, it takes 4-6 weeks to replenish all the red blood cells donated.

The following day, despite his doctor’s advice to rest, Spider-Man fights the Enforcers:

Getting weak! Doctor told me to take it easy for a while! My body hasn’t yet replenished the spider blood cells which I lost in transfusion!

He has to run away from the battle to recover (but don’t worry, he manages to catch them all the next day).

Peter is mistaken in thinking that his body has spider blood cells. First of all, spider blood is very different from human blood (it’s blue, for starters) and has only a very few cells. They have no red blood cells. Second, non-human blood cells cause serious antibody reactions in humans. Spider-Man may get his power from his blood, but it isn’t due to any spider blood cells. Peter’s a talented scientist and knows better, so I assume he was just speaking metaphorically…

Interesting sources:

1. The Blood Book. An very thorough site concerning blood and blood transfusions.
2. Two sites with good information on the biology of spiders.
3. How sick is Aunt May?

In Amazing Spider-Man #39 (August 1966), Peter Parker has a bad head cold and goes to visit the doctor. Dr. Bromwell examines him and states:

You have a whopper of a cold son – but some anti-histamine pills and a B-12 shot will have you as good as new again!

First, Dr. Bromwell recognizes that Peter just has a cold, so does not give him any antibiotics. They would not do any good, as a cold is a viral infection and not caused by bacteria.

Anti-histamines are effective against certain cold symptoms, such as sneezing and runny noses. They don’t work against every cold or every symptom. Since Peter is complaining of sneezing, anti-histamines are a good choice (they were prescription-only drugs in the 1960s). A decongestant would be another good choice, and better for his nasal congestion, though it wouldn’t do much for the sneezing.

B-12 shots are useful for people who have a Vitamin B-12 deficiency. The shots do not have any significant affect on individuals with normal B-12 levels. While many patients believe that B-12 injections will give them more energy, there is no good evidence to support this. There is some weak evidence showing B-12 injections will help certain medical conditions such as Chronic Fatigue Syndrome, but a B-12 shot will do absolutely nothing for a cold. Giving a B-12 injection to Peter would do nothing other than give him a sore arm and a thinner wallet. However, in defense of Dr. Bromwell, he is following standard medical practices of the 1960s, so judged in that light he is correct in his choice of giving Peter a B12 injection.

Finally got that long bike ride today the weather has denied me the past few weeks. It went well for the most part, but those last ten miles were killer (and the headwind was no help). Came home and crashed, and have been mostly zombie-fied the remainder of the day.

The parents came up from St Louis yesterday. My mother and the Polite-wife went shopping for lawn furniture and arts & crafts supplies, while my father and I went hiking at a couple of obscure central Illinois sites. First we went to Dickson Mounds, a state museum about mound-building Native Americans, and the Mississipian culture in general. Next, we went to the Gleason Sand Prairie nature preserve where there is about 4 square-miles of sand dunes and unusual plants and animals in the center of Illinois. There were hillsides of prickly pears in bloom, and we saw over 15 lizards and skinks in a ten minute period. Also saw a couple of deer ticks (Ixodes scapularis), but managed to get them off before they bit (no Lyme disease here!). We returned home, and all cooked a nice meal together (salad, sesame chicken, and gyoza) before they returned home.

All in all a nice relaxing and sunny weekend. Next weekend: I’m on call again (sigh).

Sunday Blog-o-bits:
1. Matt Rossi presents us with some comic stories he would like to write. The first one, concerning Tony Stark, is particularly good. I’m always up for pulp-style action, plus he references Robert E. Howard as a bonus. His second idea seems very complex and convoluted (but no more than certain Legion of Super-Hero stories and ret-cons), and while I like the idea of tying the origins of several extraterrestial races (including the Martians, Kryptonians, and Daxamites), I’ve never seen in pulled off well. Remember that issue of Star Trek: the Next Generation where it turns out the humans, Klingons, Vulcans, Romulans, etc. all had a common ancestor. It should have been graoundbreaking, but was never referenced or mentioned again (A Mopee, as Mr. Silver Age would say). His third story raises some interesting consideration as well. Well worth reading.

2. One month to the Tour de France!

3. Bible inspired diets [editor’s note: link now dead] are on the rise. This is the third article I’ve seen in last two weeks. I don’t care how religious you are, this is not a good idea. Remember, most people before the Industrial Revolution (and that includes Biblical times), were significantly less healthy than we are, and they died early (and were shorter!) due in large part to poor nutrition.

4. Finally, good news this week: cancer rates are down.

After a blood transfusion from Peter Parker in Amazing Spider-Man #10, Aunt May was exposed to “radioactive particles” and became very ill by Amazing Spider-Man #29 and nearly died. Her symptoms of fatigue, fainting and bleeding were consistent with radiation poisoning. Mortality is at least 50% at the amount of radiation she absorbed (and higher still in the elderly).

Damage from radiation depends on several things: the dose, the amount of time exposed, and the distance from the source. Some radiation poisoning symptoms can occur immediately, but most symptoms take longer to develop. Certain symptoms do not occur until years later.

Depending on the dose, immediate symptoms of radiation poisoning include nausea and vomiting, headache, fever, and diarrhea. Higher doses may cause a loss of consciousness, and it is theorized that very high doses (greater than 8000 rads) will kill immediately. Radiation burns generally appear on the skin within hours to weeks.

Delayed symptoms can include fatigue, infection, easy bleeding, hair loss, and skin lesions. The amount of time before these symptoms appear also depends on the dose of radiation; higher doses cause symptoms to appear sooner. In high doses shock, coma, and death can occur within days to weeks.

Individuals exposed to high amounts of radiation who survive the immediate and delayed symptoms have significantly higher cancer rates ten or more years later.

Aunt May received a transfusion from Peter in issue #10. Her first symptoms were noted in issue #29. In the bizarre world of comic-book time, it’s hard to know for certain how many months of radiation exposure she actually had.

Her radiation dose was undoubtedly a very tiny amount. However, because these “radioactive particles” were circulating in her blood (from issue #10 until they are neutralized in issue #33), she had a very long exposure time. She started with an extremely low initial exposure since she did not develop any immediate symptoms. Over time, her exposure increased from the “mild” level to the “moderate” level based on her symptoms. Mild symptoms include fatigue and fainting. There is no mortality at this level. At the moderate level, fatigue and fainting continue. Increased infections occur, and bleeding is very common. Mortality at this level is 50% at 6-8 weeks. Given Aunt May’s general debilitated state and ever increasing radiation exposure, it is no surprise that she went from mild to moderate to potentially lethal very quickly.

Treatment includes IV fluids, antibiotics, blood transfusion, and bone marrow transplantation. However, Aunt May was lucky and received the miraculous serum ISO-36 and recovered completely (or as completely as Aunt May ever recovers).

Yes, I know it’s a bastardization of several superior Japanese anime series, but this was the one of first cartoons that caught my fancy and inspired my imagination (the other being Battle of the Planets). The local TV station in Virginia showed it every day, and my friends and I would run home after school to watch it. Even 20+ years later, I can still sing the theme song (much to my wife’s dismay).
I have the first season on DVD, and cringe at some of the plot points and characterizations that I loved as a kid. The animation is dated and the stories are cliche (but this series originated some of those cliches), and the science laughable (Mars is light years away from Earth?). Still, it’s engrossing to watch, and I’ll sit through the series at least once a year.

As part of our Obstetrics/Gynecology rotation, we had to finish a 10 station practical exam the final week (this was in addition to the 3-hour written exam). You had 10 minutes at each station, and received a score of 1-10. The ten scores were added together to give a final score of 10-100. The tests included ultrasound reading, patient counseling, laboratory interpretation, online medical reference searches, and several stations dedicated to physical exam skills.

I was 40 minutes into the exam and felt confident. I had been able to pinpoint the placenta on the ultrasound. Online research was a snap. Talking to the patient on the phone had been relaxed and natural. Then I came to the Pap smear practical.

This station consisted of a plastic mannequin of a female pelvis and an OB resident sitting next to it. I was supposed to pretend the resident was my patient, and talk to her, but perform the exam on the mannequin. I knew the resident well as we had been on call together several nights. It was a little awkward pretending someone I knew was my patient, but I learned to cope quickly. I explained what I was doing and answered her questions. I finished the basic exam and then moved on to the Pap smear itself.

Unfortunately, plastic mannequins have a property real people don’t: elasticity. As soon as my brush touched the mannequin, it flexed, and the instrument shot out of my hand, over the heads of several incredulous students, and bounced off the far wall. Newton’s Third Law had never been demonstrated better.

The resident was trying so hard not to laugh; tears were rolling down her cheeks. Calmly and matter-of-factly I told her, “On a real patient, that would never have happened.” I then picked up a replacement brush and finished the exam without incident.

She must have believed me, because I scored a 9 on that station, and a 93 overall.

Being a history buff, I enjoyed reading H’s review of Batman Family #1 so much, I just had to track down my own copy. Batgirl (the original — no wait, the second if you count Bette Kane’s Bat-Girl) and Robin (the original) against Benedict Arnold. Benedict Arnold! Perfect — I had to read this. So thanks to e-Bay, I now am the proud possesor of an inexpensive copy of the issue in question.

First impression: I like the Mike Grell artwork. He has always been a favorite of mine – I have the entire run of Warlord, and his Green Arrow was the definitive one. Here his art is good, not as polished as he is on later books, but still good. He does seem to have an issue with drawing bizarrely triangular anatomy on Barbara, though.

The story is a riot and needs to be read to be believed. The Devil has all the denizens of Hell, and the best villain he can come up with is Benedict Arnold? Sure, it was the Bicentennial, but I didn’t think the Devil would have the Spirit of ’76. (Now that’s a bad movie. Anyone else see David Cassidy and Olivia d’Abo in The Spirit of ’76? Ugh.)

As can be expected, the story is a mish-mash of historical accuracy. Barbara’s retelling of the history of Benedict Arnold left out most of the reasons he turned traitor, such as repeated politically-based court martials, serious debt, and a socially ambitious Loyalist wife. I expected better from a librarian turned Congresswoman. Admittedly, she was filming a public service announcement, so she’d be lucky if anyone actually watched it.

The anachronisms were thick. I was struck by Arnold’s understanding of modern (well, modern in 1976) media. He not only knows what cameras and film are, but knows what the “airwaves” are. They get TV down in Hell now? Plus, how did he know who Stonewall Jackson was?

At the battle of Saratoga, Arnold suffered a serious injury in his left leg, leaving him lame. Yet he’s walking and running fine in this comic. I’m sure the Devil fixed him right up, but I would have asked him to do something about that pot belly as well.

Don’t get me wrong: despite all my nit-picking, I thoroughly enjoyed the story. The premise alone is worth the price of admission.

The rest of the stories are a mixed bag. The Alfred story was a lightweight one from back in the days when he was more of a bumbling character. I prefer him the clever, quiet and somewhat condescending character he is now.

I can’t add much to H’s critique of the Commissioner Gordon story except to say that Robin’s dialogue is particularly painful. Remember that scene in Better Off Dead where Lane’s father is trying to talk “hip” to him? It’s like that, but even worse. Adults should not try to write trendy teenage dialogue. Period.

I enjoyed the Man-Bat story. I had never read it before, and always liked the character. Neal Adams and Dick Giordano present us with some beautiful and appropriately moody art. In terms of the story, I did find it interesting that Batman welcomed the new “hero” with open arms, as opposed to his “get the hell out of my Gotham” attitude nowadays.

Inhumans #11 and 12 No Matter the Cost, parts 3 and 4
Sean McKeever, writer
David Ross, penciler

The beginning of Inhumans #11 is well done. Through a series of sepia-toned memories and family pictures, the back story of Terry Halley Jr., the antagonist of the tale, is told.

His brother William dies at age 8 from an aortic aneurysm. It is very unusual for a child to die of an aortic aneurysm unless it was caused by blunt trauma (which this wasn’t). Most aortic aneurysms are due to bad arteriosclerosis (hardening of the arteries) and occur in older individuals. Some childhood aneurysms are caused by Marfan’s Syndrome, a genetic disorder that has a definite look to it — tall and thin (think Abraham Lincoln; there is some speculation that he had Marfan’s). About 2% of other aortic aneurysms are congenital, and this is probably what his brother had. McKeever is right that a ruptured aortic aneurysm will kill instantly.

His father dies at age 52 from “complications due to liver failure.” The main cause of liver failure is alcohol abuse. Sure enough, if you look at the three family pictures of Terry Haller Sr., he is always holding a drink, and looking more and more disheveled in each picture. Clever.

Both his mother and wife die of “accidental overdoses” of medicines. I suspect his mother’s was a suicide (so soon after the death of his father), and his wife’s probably was too. Most overdoses of antidepressants are.

His son is born with an unnamed genetic condition. Terry tries everything to cure his son including gene therapy, holistic medicine, shamans, and psychics but nothing works.

Gene therapy is a fascinating concept. Basically, in a genetic disorder where we know which exact gene is wrong, is there a way we can correct it? Muscular dystrophy, cystic fibrosis and sickle cell anemia are all good candidates for this therapy because we know precisely which gene is incorrect. The problems lie in getting the good gene into the right place in the correct cell without causing more problems. Not an easy task and no good solutions have been found…yet. Watch for gene therapy to advance dramatically in the next decade.

Nitpick time.

1. In issue #11 and #12, Terry Haller’s son is shown in a hospital bed with what looks like a large wire going to his left chest. I assume this is supposed to be the lead to his cardiac monitor, but monitors require 4 small leads, not one large one.
2. His nasal canula (oxygen tubing) in issue #12 is wrong as well. I’ve covered this before (with pictures!) so I won’t go into depth here.
3. Finally, at the end of Inhumans #12, Nahrees is reunited with her “boyfriend” Damon, who she believed had been killed. In issue #10, Damon is shot in the back and falls about 1 foot to land on the grass. Yet in the hospital he is shown with his head swathed in bandages, and his hair shaved as if he had brain surgery. It’s not clear how he went from shot in the back to a head wound. Maybe the bad guy ran him over with the car as he left?

While children are fairly common in comics, pregnancy has only rarely been shown. The following is an informal list of pregnancies that have been shown, or *may have been shown* in comics. The list is entirely from memory, and so ommissions and mistakes are probably quite common. I am striving for a list not of characters who have been pregnant, but whose pregnancy has been shown in comics.
I would appreciate any additions.
This list does deal primarily with super-hero comics because that is what I am most familiar with, but I welcome non-super-hero suggestions as well.

Heroes:
AQUAMAN
Dolphin and Garth (Tempest) recently had their son Cerridan. I missed a bunch of Aquaman, so I don’t know if they ever showed the pregnancy.

FANTASTIC FOUR
Sue Richards lost her first pregnancy, but then had Franklin with her second. A magical/time-stream induced third pregnancy recently gave the Richards a daughter, Valeria.
Lyja Storm, as I recall, was pregnant and gave birth to an egg(?)

INCREDIBLE HULK
Betty Banner was pregnant, but miscarried.

FLASH
Iris was pregnant with twins at the time that the silver age Flash (Barry Allen) died.
Linda West lost twins recently in the current Flash.

INFINITY INC.
Hippolyta Hall was pregnant a *long* time, and ultimately gave birth to Daniel.

ANIMAL MAN
Annie was pregnant and gave birth in the last issues of the series.

JSA
Hawkgirl was pregnant as a teenager, but this was presented after the fact, so probably shouldn’t be on this list.

STARMAN
Jack fathered children with the Mist (see below) and his significant other, Sadie.

LOSH (1)
Garth Ranzz (Lightning Lad) and Irma Ranz (Saturn Girl) had twins. Now, twins are the usual on Winath, Garth’s home planet; however, Irma come from Titan. Plus are the twins fraternal or paternal? Both have been shown on Winath in the series.

LOSH (2)
In the “five years later” Legion, Night Girl was not only married to Cosmic Boy, but also pregnant.
Also Laurel Gand had a child.

LOSH (3)
Apparition (Tinya Wazzo) and Ultra Boy (Jo Nah - you talk about bad puns, his name was ‘Jo Nah’ and he was swallowed by an outer space whale) have married and had a child (Cub).

L.E.G.I.O.N.
Stealth had a child by Vril Dox.

AVENGERS
Wasn’t Ms. Marvel impregnated by some extraterrestrial being at one point?

TEAM TITANS
Donna Troy was pregnant at the beginning of this series.
Wasn’t Mirage pregnant at the end?

X-MEN
Madelynne was pregnant with Scott Summer’s child (and gave birth to him) in the X-Men.

Villains:
Punch & Jewlee
They showed up in Hawk & Dove toting a toddler, but I don’t know if the pregnancy was ever mentioned or shown in Suicide Squad or elsewhere.

Chesire
Gave birth to Lianne, fathered by Speedy/Arsenal (Roy Harper), but I don’t know if the pregnancy was shown.

Mist
Had a child by Jack (Starman). Do not recall if the pregnancy was shown.

Non-Super-Hero:
STRANGERS in PARADISE: Francine recently miscarried.

In my junior year at college, my hardest class was Physics 197. This was the second semester of general physics for science majors. It was harder than the first semester, because it dealt with more abstract concepts such as optics, electromagnetic waves, and quantum mechanics. It was taught by Dr. Bender, a Harvard-trained quantum physicist who liked to inject a little history into his lectures.

Dr. Bender had just finished up a particularly dense discussion of some of the finer points of quantum electrodynamics. He then started brought up some of the scientists who had made the field famous including Albert Einstein, Richard Feynman, and Freeman Dyson.

Looking around the large lecture hall, he asked if anyone had ever heard of Dyson.

Without thinking, I raised my hand. Surely if I had heard of him, lots of other students would know him as well. When the girl next to me nudged me in the ribs, I was mortified to discover I was the only one with my hand in the air.

“How have you heard of Dyson?” Professor Bender asked.

“Dyson spheres*,” I replied, my voice echoing in the still air.

He looked at me closely for a second, then nodded and said, “Very impressive.” Turning back to the chalk board, he resumed the lecture as the rest of the class glared at me.

I didn’t have the heart to tell him I only knew about Dyson spheres from reading about them in a comic book. Who knew all those years ago that New Mutants Annual #1 would make me seem smart to a university physicist? A dollar well spent.

*This was several years before the Dyson Sphere/Scotty returns episode of Star Trek: The Next Generation.

I’ve just finished the third issue of the new She-Hulk, and find myself quite enamored of the series. The story and art combine well to make a compelling read.

The art by Juan Bobillo is good in the way that it is deceptively simple, yet conveys the story well. There have been some complaints that his She-Hulk/Jen looks too much like a kewpie doll, or too young. While I agree that she is somewhat “kewpie” looking, I don’t think she looks too young. The art is emphasizing the waif-ness of Jen, and the simplicity of the She-Hulk (if she can’t smash it she doesn’t know want to deal with it). Each character is distinct, and his backgrounds are well drawn. The man absolutely cannot draw the Thing though.

Dan Slott does a good job with stories that highlight both sides with the Jen Walters/She-Hulk dichotomy. She-Hulk was shown as a wild party girl in the first issue, but that fit with her past portrayals. In the recent Avengers, Geoff Johns has shown her to be all business, but it’s always been well established that she has constantly favored her She-Hulk side and the freedom it represents. She’s always been a bit of a wild card, too. Remember that when she first joined the Avengers, she knocked Hawkeye’s taxi upside down, then picked up her own convertible, hoisted it on her shoulder, and carried it to the mansion.

I appreciate the fact that the stories play up Jen’s native intelligence and abilities. It’s been a long time since plain Jen Walters had a chance to shine. It was Jen who won the court case in issue #3, not the hot-shot lawyer. It’s clear that she’s realizing the importance her long forgotten human self just as she is beginning to understand that She-Hulk is just being used, particularly by the aforementioned lawyer.

The court cases shown in issues #2 and #3 are cleverly conceived. Both deal with situations that could logically arise in a super-hero universe. Both cases are concluded capably. Dr. Strange also makes supporting (consulting, really) appearances in both issues, but I don’t remember him being as omniscient as he is portrayed here though.

There is some enjoyable subtle humor in the issues as well. When Jen’s new neighbor is attacked by the Avenger’s security system of “super-strong carbonadium alloy”, he accuses her of just making up words. A few panels later, Jarvis shows up wielding a baseball bat and wearing a pan on his head; the pan he assures Jen, is made of “forbushion alloy.” Finally, in court, the Infinity Gauntlet is referred to as “Thanos v the Universe”, as if it were a court case.

Last but not least, I appreciate all the single-issue stories. While each issue builds on the previous one, each story is entire in itself. This is a nice change from the decompressed storylines in vogue now.

The Goblin Reservation, by Clifford D. Simak, tells the story of Professor Peter Maxwell. In the not too far future, humanity has rediscovered all the creatures of legend – elves, trolls, goblins, banshees, and so on. All of the supernatural creatures have been accounted for except the dragon. Maxwell, a professor of Supernatural at the University, has made it his life’s work to find a dragon.

As the story begins, Maxwell arrives back on Earth by matter transporter after spending several fruitless weeks searching a distant star system for rumors of a dragon. His transmitter beam was hijacked on his way to Earth, and he found himself a guest on a mysterious crystal planet for several days. While there, he was asked to share the immense knowledge of this mysterious planet with Earth.

He finally returns home to discover that his transmitter beam was not hijacked, but duplicated. Another Peter Maxwell returned two weeks before and died in a mysterious “accident.” Maxwell’s attempts to re-establish his life are complicated. His apartment has been leased to a new tenant – a graduate student with a pet saber-toothed tiger. His teaching job no longer exists. His friends want him to pay back the money they spent on his funeral wreath.

Meanwhile, he is trying to figure out what to do with this knowledge he has been asked to share. He is approached by a group of mysterious aliens, the Wheelers (who look like giant pill bugs on wheels), and who seem to know too much and wish to purchase this knowledge from him. How can he reconcile his own loyalties, return to his previously happy life, and fulfill his appointed duties wisely?

The book showcases the common Simak themes. The first is the search for knowledge. As a former newspaper reporter, Simak injects this into almost all of his characters, many of whom are reporters themselves. In The Goblin Reservation, the character Ghost represents this quest in its most basic sense. He knows that he is someone’s ghost, but he can’t remember whose. Peter Maxwell represents this idea turned on its end. Maxwell has the knowledge – but doesn’t know what to do with it. Who is he supposed to give the knowledge to, and how? The quests of both the Ghost and Maxwell are an integral part of the novel’s ultimate outcome.

Simak’s stories commonly show the struggle between the urban and rural ways of life. This is often shown as conflict between technology and the “simple life”. His characters are generally unassuming individuals thrust into some technological conundrum. In this novel, the Wheelers represent the technological aspect while Maxwell himself represents the uncomplicated rural lifestyle. Both his caveman friend, Alley Oop, and his goblin friends represent the ideal of the pastoral life; another concept common in Simak’s novels.

All of Clifford Simak’s science fiction novels are unreservedly recommended. He was a not a multiple award winner (Nebulas and several Hugos) by accident. His stories, originally written in the 1960s and 70s, still ring true today.

The Goblin Reservation is more light-hearted than most of Simak’s other novels. It is a near-perfect blend of action, humor, and conscience and has my highest recommendation.
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Rashes are fascinating. They are one of my favorite diagnoses to see in the office. It is amazing that the skin, a single organ, can respond in so many entirely different ways to a limited number of causes. Rashes can be red, blue, purple, red, white, brown or almost any other color of the rainbow. There are hundreds of textures, including bumpy, solid, flaky, or even slimy. There can be no pattern, a ring pattern, a swirl pattern, a Christmas tree pattern, or any of hundreds of other patterns.

Rash identification breaks down into three possibilities, all fairly equally spread. This gives us Scott’s Rule of Rashes:

1. One-third of the time I know exactly what it is. (“Why, that’s pityriasis rosea“)
2. One-third of the time I have a general idea of what it is, and a good idea of how to treat it. (“That looks like some kind of irritant dermatitis. We should be able to calm it down with a steroid cream.”
3. One-third of the time I have no idea.

I first formulated my rule of rashes when I started my career as an Air Force physician. As I’ve gotten more experienced and entered private practice, I find that the rule still holds true for the most part, although there’s less category 3 and more category 2 now.

I should have known from the start that it was going to be a bad day. I woke up late, which is unusual for me, so I didn’t have time to shave before I had to leave for my OB rotation at St. John’s Mercy Medical Center. My overnight kit was in the student call room, so I knew I’d be able to shave at the hospital before rounds started.

As I was walking into the OB ward, a couple of the nurses I passed mentioned that I was looking pretty pale. I just smiled and said, “I’m always pale.” Not until I was shaving did I realize that I really did look pale. I had given blood the day before, so that probably explained most of it. I wasn’t worried; our routine was always the same: pre-rounds on the OB patients with the residents, a leisurely breakfast, then full rounds with the attending physician. I would have plenty of time to rehydrate and get a good breakfast.

Unfortunately, things didn’t work out that smoothly that morning. In the middle of our pre-rounds, an emergency C-section came in. The attending grabbed the two residents and me, and we all scrubbed in to the surgery.

The surgery went well, and the infant was delivered quickly and without any difficulty. The attending turned to the youngest resident. “Steve, have you ever sewed up a C-section?”

“No, sir,” he said.

“It’s all yours,” the attending replied, removed his gloves and gown, and stepped out of the room.

The trick to a C-section is that there are many different layers involved (OK, the real trick is to get the baby out – that’s definitely first). You need to sew up the uterus, the peritoneum, and then the skin itself. Sometimes multiple layers of suture are placed in the uterus or the skin. An experienced physician can do this quickly, and sew up all the layers in no more than 5 minutes. She will usually staple the skin layers, as staples heal well, and are fast to put in and easy to take out.

Steve, however, was anything but experienced. Slowly, very slowly, he began to examine every square inch of the uterus. He took the needle holder and suture and made a very small, precise stitch. He looked closely, and then took another stitch. This laborious process was repeated for the sixty tiny stitches he used to close the inner layer of the uterus. He then started on the outer layer, using a slightly bigger suture, but the same slow routine. By the time he was finished with the uterus and started on the peritoneum, we had been in the OR for over an hour.

I started to get very sweaty. The gown, mask, and cap that everyone has to wear in the operating room are always very warm, but this was worse than usual. I developed a cold sweat and then began to feel a little nauseous as well. I took a deep breath to clear my head, and took a firm grip of the table to steady myself.

Meanwhile, Steve continued his slow, precise suturing.

My sweats got worse. I started to shake and get a little light-headed. I gripped the table tighter, and concentrated on what Steve was doing.

He had finally finished repairing the peritoneum and moved on to closing the skin. Please, I prayed, use the stapler. Instead he picked up more suture and carefully measured the incision before he started in with another tiny stitch. He took a second stitch then stopped, eyed the incision critically, and pulled both stitches out.

Sweat was pouring down my face and my vision was blurring. I was feeling dizzy but I was determined to make it through the C-section. Steve had started again and placed three stitches in the incision. He stopped, measured, and placed two more stitches. Another pause, then another stitch. He stopped again and ripped the last stitch out before starting again. He had repaired barely one inch of the eight-inch incision.

At this point, it was taking all my effort to stand upright. I had visions collapsing face first into the operating field. I stepped away from the table, ripped off my surgical mask, gown, and gloves and bolted from the room. I stumbled down to the doctor’s lounge and collapsed on the couch.

After five minutes, I got up and crawled to the fridge. Opening it, I found a can of Coke and quickly drank it down. After another half-hour and another Coke, I felt strong enough to leave the lounge. I returned to the ward, where Scott had just finished the C-section. I walked up to him and apologized for breaking scrub and leaving the OR.

“You left?” was his puzzled reply. He was so intent on suturing that he had never even noticed that I had left. He teased me about leaving the OR for the rest of the rotation.

I should have kept my mouth shut.

I love video games. I have been playing video games for close to two decades now, and own a few (ahem) game systems. As I get older, however, I find that fewer and fewer games are appealing to me.

In some cases, the subject matter itself, or the way it is portrayed, is offensive. Some genres and titles just don’t interest me (football games, for example). Most of the problem is that I’m just not getting my money’s worth out of games anymore. Ironically, it’s not because they’re too short, but instead they are too long. When I was in school, or even residency, I had a lot more free time. When I was off duty, I was free. No “home call”, no family, no house to take care of. Then, I could spend 90+ hours finishing Final Fantasy VII. Now, that’s no longer practical. I need games that don’t go on forever. Games that don’t require a hint book. Games that I can finish before I lose interest.

The industry needs to pay more attention to the desires of mature gamers. We need games that are playable, fun, and finishable. Mature gamers may not be as numerous as younger gamers, but I suspect we have a great deal more money.

I would like to see games that:

• Can be finished in a few good weekends (around 30 hours of gameplay).
• Have a gentle learning curve and a logical control scheme.
• Are replayable (hidden areas, power-ups, etc.)
• Have good graphics and a good storyline.
• Are divided into manageable areas and have a good save system.

True, some companies make “budget games” that are shorter, but they generally are of shoddy quality all around. I want to see big budget games that can be enjoyed by people with limited time (and in some cases, limited abilities).

The two Ratchet & Clank games are good games. The basic game takes just about 20-30 hours, but there are many areas to go back and explore after the game itself is finished. Saves are logical, and finishing a level is a good nights play. The graphics are good, the voice acting excellent, and the story line in engrossing with lots of humor.

Primal is also a contender. The game is longer, but allows you to save anywhere. The graphics are excellent, and it has the best voice acting I’ve ever heard. The captivating story is easy to follow yet captivating.

The new Pitfall games does not come close. The control scheme is awkward and the save game scheme poorly thought out. The levels vary from simplistic to near-impossible-to-figure-out-what-the-designer-had-in-mind. The story and graphics are childish.

The score…. Ratchet & Clank 1 & 2: good. Primal: good. Pitfall: Bad. A game industry that listens to mature players: Important and needed.

Another dreary Sunday in Illinois, so the long bike ride gets put off again. I managed to get a moderately-long very-fast ride in yesterday, so all is not lost, but I was looking forward to a nice long ride today. On the bright side, the rain gives me an excuse for not mowing the lawn.

The Polite-wife and I went to see Harry Potter and the Prisoner of Azkaban last night. It was excellent and enjoyable from start to finish. This was the best of the Harry Potter moviesso far, and the new director gives it a much more cinematic feel than the previous movies. I particularly liked his subtle way of showing the seasons changing by focusing on the Whomping Willow without having to explicitly state “It’s fall now.” The acting was superb. I think this is one of the fist movies I’ve seen with Gary Oldman where (spoiler warning) he was not the bad guy.(end spoiler). David Thewlis (who played Professor Lupin) was also good — I know I’ve seen him somewhere before but I’m sure where, and IMDB did not help this time. In terms of cameo roles, I liked seeing Dawn French (of French & Saunders and Vicar of Dibley fame) as one of the paintings, and Peterson from Red Dwarf as Ron’s Father.

Michelle at the Underwear Drawer has some excellent thoughts on medicine, a life in medicine, and medical blogging. If you have any interest in medicine, go read it (the comments too). The Dr. J quote is wonderful. There are certainly days when I wonder whether a life of clinical medicine was the right choice, but then I realize that there’s absolutely nothing I would rather be doing. So, right choice! It’s certainly true that some physicians make a great deal of money, but I can guarantee that none of those doctors are primary care doctors (family practice, internal medicine, pediatrics). No one goes into primary care for money, but rather for the enjoyment of the job.

Other Sunday Blog-o-bits:
1. Three weeks until the Tour de France!! (Go Lance!)
2. The Food Whore. An enjoyable blog by a caterer. A fun read, particularly if you’ve ever worked in catering or the restaurant business (I had to pay for college somehow!). Thanks to Ilyka for the link.

Fantastic Four #73 (Third Series) 5th Wheel, part 2
Mark Waid, writer
Casey Jones, artist

In Fantastic Four #73 (or #502, depending on which numbering system you use), Reed Richards and Johnny Storm traveled back in time and cut a sample of hair from Victor von Doom’s head. Reed then uses the DNA from this sample to make armbands protective against Castle Doom’s defenses in Fantastic Four #74.

The problem is that hair is composed of protein molecules and not cells and has no DNA. Hair samples can have DNA if they are pulled out or fall out, as most of these hairs still have the follicle attached, which does have cells and DNA.

However, Reed cut a hunk of Doom’s hair off with a laser – leaving no follicles, and no DNA. (Now maybe Doom had bad dandruff, so some scalp flakes were in the hair sample allowing Reed to get the DNA he needed. This bad dandruff would have led to awkward teenage years and rejection after rejection from the girls. His self-esteem plummeting, Doom had no choice but to flee Latveria for schooling in the U.S. Furthermore, the teen angst he experienced due to his bad dandruff could have been the spark that led him to seek revenge and world domination. And to think that Dr. Doom’s megalomania could have been cured by a bottle of Selsun Blue…)

As Dr. Midnight’s associate Nite-Lite gives Hourman and Wildcat a tour of the Cross Medical Clinic, he explains why they have a room full of high-tech equipment:

Last year, a self-aware strain of Camel Pox callin’ itself the seeing plague blinded three-hundred people in Portsmouth…Doc says we gotta be prepared with more than a pair of eye scissors and aspirin.

Camel Pox is a real disease caused by a virus closely related to Smallpox. It causes fever and mouth sores on camels. There have been no cases of Camel Pox infecting humans. There is some concern that it is close enough to Smallpox to have the potential to infect humans if it mutates (or is mutated) the wrong way.

A cluster of infection from a mutated Camel Pox virus is well within the realm of possibility. I would expect symptoms similar to its effects in camels, but with a self-aware virus, I guess anything is possible. (But why does a virus calling itself “The Seeing Plague” cause blindness?)

The Adventures of Pete & Pete was a great half-hour comedy that used to be shown on Nickelodeon (and now sometimes appears on Noggin). It follows the adventures of two brothers both named Pete. The older Pete is in high school and a reluctant conformist, while the younger Pete is in junior high and a serious rebel. Their parents were pretty much the typical clueless sit-com parents, but each brother also had their own group of friends – and enemies. The older Pete’s best friend was Ellen, and his enemy “Endless” Mike. The younger Pete has best friend Nona (played by Michelle Trachtenberg…better known as Buffy’s sister, Dawn), and a group of adversaries including Pit-Stain and Hair-Net.

The show had a definite surreal quality about it, and never took anything seriously. Show subjects included turtles, curfew, dating, adult jobs (ugh!), bowling, fishing, lawn care, ice cream, and tricycle racing.

Guest stars were common. Adam West had a recurring role as the junior high principle and Steve Buscemi played Ellen’s father. Other guest shots included Michael Stipe, Debbie Harry, Iggy Pop, Janeane Garofalo, Bebe Neuwirth, Syd Straw, LL Cool J, Frank Gifford and even Hunter S. Thompson.

Some of the best episodes include “Time Tunnel” (using Daylight Savings Time as a means for time travel), “35 Hours” (Dad and Mom go on vacation; Pete and Pete sell the house), and “Last Laugh” (Pete is determined to pull an April Fool’s Day prank on the Principal).

Ostensibly a children’s show, there was a great deal of mature humor and clever cameo roles. If any show is deserving of the DVD treatment, this is it!

JSA All-Stars #5 An Hour at a Time
Geoff Johns and David Goyer, writers
Adam DeKraker, penciler

This this issue focuses on Rick Tyler, the current Hourman and son of the original Hourman. While there is some decent medicine in the story, there is an abundance of bad medicine, plus some serious logical errors as well.

Rick is talking to his mother about his reformulation of the drug Miraclo, which gives him his “hour of power”:

It’s a homeopathic solution now. Delivered through a transdermal patch in my glove.

The fact that Miraclo is “homeopathic” makes no sense. Based on an 18th century medical theory, homeopathic medicines follow two basic principles: the Law of Similars, and the Law of Infintessimals. According to the Law of Similars, to treat a particular symptom a substance that causes similar symptoms is used (for instance, you’d use a substance that causes a fever to treat a fever). The Law of Infintessimals states the more dilute a solution is, the stronger its effect. Homeopathic solutions are diluted by orders of magnitude to such an extent that it is statistically unlikely that even one molecule of the original substance is left in the final preparation.

Leaving aside the scientifically dubious claims of homeopathy, let’s focus only on the Law of Similars. Super-powers are not a symptom. How can you “treat” super-powers by using another substance to cause them? I suspect the writers are using “homeopathic” to mean natural, or non-synthetic, but the terms are not interchangeable (they mean very different things). As it stands, Rick’s comment is technobabble at its worst.

Transdermal administration of Miraclo is a possibility. Many drug preparations are available now that are absorbed through patches on the skin. However, the absorption of medicines through the skin tends to be a slow process, and is best for long term steady-state drugs (like hormone replacement or pain killers). It wouldn’t be fast enough to give Rick his power when he needed it.

Next, in the middle of lunch, Rick has a premonition that a man is going to commit suicide by jumping from the top of a nearby skyscraper. He rushes to stop the man.

After racing to the top of the building, Rick has a sudden realization that he has an addictive personality. This makes sense. There are certainly people who have problems with addiction after addiction. It makes since that Rick, who was once a drug addict, now gets his kicks from the adrenalin rush of being a hero.

Speaking of Rick racing up to the top of the building, why did it take so long? It took him over 50 minutes to get from the 1st floor to the roof (80 flights of steps). It took me 47 seconds to climb 5 stories (10 flights) of steps at the hospital this morning. At that rate, it should take 12:32 to reach the top of an 80-story building. Admittedly, this calculation does not take fatigue into account, but 1) I walking briskly, not running; and 2) I didn’t have Miraclo surging through my body. It should not have taken Rick that long to get to the roof.

The numbers make even less sense when they are broken down further:

It took nearly two minutes per floor for the first six, but only six-seconds per floor for the last 22. It seems that I was right about transdermal being slow, and it took over 50 minutes for the drug to kick in.

Finally, let me point out the “count-down clock” in the issue is not counting down Rick’s hour of power, but instead the amount of time until the man jumped to his death. Rick’s hour started at least a minute and 16 seconds later. The whole ending, where Rick runs out of power just as the man jumps, is contrived. He still had at least a minute of power left.

After picking on Hourman in JSA All Stars #5 last night, I now turn my attention to JSA All Stars #6, where I get to pick on one of my favorites, Dr. Mid-Nite.

JSA All-Stars #6 Out of the Shadows
Geoff Johns and David Goyer, writer
Stephen Sadowski, penciller

In the prologue to the story, the Spectre states that Dr. Mid-Nite (Pieter Cross) “lost his residency after exposing an insurance scandal”. Assuming Dr Mid-Nite is practicing medicine legally, he must have completed at least his first year of residency training, as this is required to obtain a medical license (some state require two years). Addendum: According to the Washington State Department of Health, two years of residency are required for a full medical license if the physician graduated after 1985. Foreign medical graduates face extra requirements. Pieter mentions that he was born in Norway, but it has not been explicitly stated when he came to the U.S.

Exploring the scene of a gas main explosion, Pieter finds a pregnant woman trapped in a subway car. Carrie, the pregnant patient, informs Pieter that she cannot move because her water just broke. In other words, the membrane holding the amniotic fluid which surrounds the infant has ruptured. Generally, delivery comes shortly (but not immediately) after the rupture, but this is quite variable. Note that Carrie says nothing about contractions, or “being in labor”; other than the rupture of the amniotic membrane, there is nothing more to suggest that delivery is imminent. It would be a good idea to move her to a safer location prior to childbirth.

Dr. Mid-Nite uses his ultrasonic vision to check out the infant. His ultrasound is extremely detailed, much more than current technology, but then he has always been ahead of the curve. There seems to be quite a bit of amniotic fluid surrounding the infant for a mother whose water just broke.

Next, Pieter uses a spray to sterilize everything around them. How necessary is this? Opinions vary. Childbirth is an inherently messy and non-sterile situation. Certainly, extra precautions and cleanliness never hurt. The most important thing (particularly for the mother) is for the doctor to have clean hands during the delivery. However, Dr. Mid-Nite never washes or sterilizes his hands, despite handling debris, skin, and clothes before delivering the baby.

Pieter offers Carrie the narcotics meperidine (Demerol) or butorphanol (Stadol) for the pain, which she declines. Meperidine is not used much in the U.S. for pain control during childbirth, but butorphanol is still common. Generally, narcotic drugs are avoided because they have the potential of slowing the infant’s respiratory drive. As noted in a previous post, offering narcotics to this patient is legally questionable.

Dr. Mid-Nite successfully delivers an infant girl. Umm, where’s the umbilical cord?

After the delivery, Dr. Mid-Nite escorts Carrie and her new daughter to medical help:

The child’s fine. But the mother has a fractured ankle. Minor lacerations. And they both need oxygen stat.

If the infant is fine, then why does she need “oxygen stat.” Same for the mother; if she only has a fractured ankle and minor lacerations, why does she need oxygen.

Maybe they both suffered smoke inhalation, in which case oxygen is an appropriate therapy…but then the infant wouldn’t be “fine”, and Dr. Mid-Nite should have mentioned smoke inhalation in his report to the medics.

To end on a good note, Pieter did swaddle the infant, keeping it warm. This is very important in newborns, as they have poor temperature regulation.

I was sitting at my table in the hospital tent early one Wednesday evening, typing on my laptop, and trying not to think about the 120 degree heat we were experiencing on our deployment in the Arabian Peninsula.

The tent door opened, and Gene, one of the vehicle maintenance sergeants, came in.

“Doc,” he said. “Something funny’s going on with my right eye.”

“What’s that?”

“I haven’t been able to see well out of it for the last couple of days. There’s one spot where I can’t see at all.”

I beckoned him over to sit down on the cot and looked closely at his eye.

“Did you injure your eye? Or get anything in it?”

“I don’t think so.”

I did a quick exam, and both eyes moved and responded normally. I got out my ophthalmoscope, and looked at his retinas. This is a difficult exam to do under the best of circumstances, and in a bright hot tent it was particularly difficult. Both retinas looked pretty normal, though there seemed to be a slightly pale spot on the right.

I did a confrontation exam, which revealed that he had a fairly significant blind spot in the upper outer quadrant of his right eye.